Coblation intracapsular tonsillectomy in a paediatric tertiary centre: Revision surgery rates over a nine-year period.

OBJECTIVES: Coblation intracapsular tonsillectomy (ICT) is increasingly being used in the paediatric population because of the rapid recovery and low rates of complications associated with it. There is, however, a risk of symptomatic regrowth with this technique. The objective of our study is to establish the rate of, and risks for, revision surgery over time in a major tertiary referral centre with a large cohort of paediatric Coblation ICT cases. METHODS: A retrospective review of all children (0-19 years) undergoing Coblation ICT from April 2013 to June 2022 was undertaken, using electronic databases and clinical records. Post-operative follow up was reviewed and revision cases were subsequently identified and examined. Statistical analysis was performed using a Chi-Squared test. RESULTS: 4111 patients underwent Coblation ICT during the studied period, with or without concomitant adenoidectomy. Of these, 135 (3.3 %) required revision tonsil surgery, primarily for recurrence of initial symptoms; two patients required two consecutive revision procedures (137 revision procedures in total). Eight-eight (n = 88) (64 %) of these were revised with a repeat Coblation ICT procedure and 49 (36 %) with bipolar diathermy extracapsular tonsillectomy (ECT) of remnant tonsil tissue. The revision rates after Coblation ICT declined steeply on a year-on-year basis since the commencement of this technique (from 10.6 % early on, to 0.3 % at the end of the study period P<0.001). A significantly higher revision rate was noted in children below the age of two at the time of primary surgery, compared to those older than two years of age (P<0.001). CONCLUSIONS: This study demonstrates real-world departmental revision rates over a nine-year period from the technique's commencement of use. With Coblation ICT, symptomatic re-growth occurs rarely, but may be clinically significant, with higher rates of recurrent symptoms seen in children under two years of age at the time of primary surgery. The revision rate apparently drops over time in parallel with overall experience of surgeons and formalised training.

The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors.

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC), the most common cancer capable of metastasis, has variable reported metastatic rates and the impact of individual risk factors for metastasis is unknown. METHODS: This study examined pathology records of excised cSCC over a 10-year period. Uni-variate and multi-variate analyses including patient demographics, maximum clinical diameter (MCD), anatomical sub-site, histological differentiation, perineural invasion (PNI), and lymphovascular invasion (LVI) of the lesion were performed. The primary endpoint was time to metastasis. RESULTS: Six thousand one hundred sixty four patients (median age 74 years) underwent excision of 8,997 primary cSCC. During the median follow-up of 70 months, the metastatic rate of cSCC was 1.9-2.6%. Multi-variate analysis showed that MCD (hazards ratio 1.41 [95% CI 1.25-1.60] P < 0.001), PNI (5.29; P < 0.0001), poor histological differentiation (4.26; P < 0.0001), location in the ear and retro-auricular area (3.31 [1.17-9.33]; P = 0.0024), cheek (3.18 [1.15-8.81]; P = 0.026), and lip (4.84; P = 0.009) increased the risk of metastasis. CONCLUSIONS: We show a 1.9-2.6% metastatic rate for cSCC with MCD, histologic differentiation, PNI, and certain anatomical sub-sites being independent risk factors for metastasis. A prospective study on our proposed risk stratification scheme based on these parameters may lead to identification of high-risk lesions that would benefit from more intensive treatment and/or routine post-operative follow-up.Inc.